罗哌卡因和吗啡胸段病人自控硬膜外镇痛治疗不稳定型心绞痛的临床观察

THORACIC EPIDURAL ANALGESIA WITH ROPIVACAINE AND MORPHINE BY PATIENT CONTROLLED EPIDURAL ADMINISTRATION FOR THE TREATMENT OF UNSTABLE ANGINA PECTORIS

目的 :应用罗哌卡因和吗啡 ,采用胸段病人自控硬膜外镇痛 (PCEA)方式治疗不稳定型心绞痛 (UAP) ,观察治疗效果及副作用。方法 :32例UAP病人 ,随机分成两组 ;Ⅰ组胸 3～ 4穿刺置管 ,采用负荷剂量 (0 .2 5 %罗哌卡因与吗啡 1mg混合液 5ml) +持续剂量 (0 .0 75 %罗哌卡因与 0 .0 0 1%吗啡混合液 ;1～ 4ml/h) +PCA (2～ 3ml/次 ,锁定时间为 30min)行PCEA治疗 ;Ⅱ组采用内科常规药物治疗。两组根据病情需要 ,静脉滴注硝酸甘油 ,观察心绞痛症状治疗前后效果及心电图恢复率 ,记录硝酸甘油、吗啡、罗哌卡因用量及血压、心率变化。结果 :心绞痛症状治疗前后效果及心电图恢复率Ⅰ组均较Ⅱ组有显著改善 (P <0 .0 1) ,硝酸甘油用量Ⅰ组显著小于Ⅱ组 (P <0 .0 1) ,血压、心率无明显改变 ,未发生其它副作用。结论 :罗哌卡因、吗啡PCEA治疗UAP安全有效 ,其远期疗效有待进一步随访观察。

Objective: Ropivacaine and Morphine were used for thoracic epidural analgesia to treat unstable angina pectoris(UAP) via patient controlled epidural administration (PCGA), and the therapeutic effect and side effects were observed. Methods: 32 patients with UAP were divided into two groups. They were punctured and placed tube in thoracic 3～4, receiving loading dose (5ml mixture of 0.25% ropivacaine and 1mg morphine) and persistent dose (mixture of 0.075% ropivacaine and 0.001% morphine, 1～4ml per hour) , then PCEA (2～3ml each time, locked at 30 minutes) for group Ⅰ; Group Ⅱ was given routine medical therapy.According to the state of illness, intravenous drip of various doses of nitroglycerin, was given and the degree of angina before and after the treatment and the recovery of electrocardiogram were recorded, as well as the dosage of nitroglycerin, morphine and ropivacaine, blood pressure and the change of heart rate. Results: The degree of angina and the recovery of electrocardiogram in groupⅠwere significantly better than those of groupⅡ ( P <0.01), and the amount of nitroglycerin used in groupⅠwas much smaller than groupⅡ ( P <0.01). There were no obvious changes in blood pressure and heart rate, nor aversive side effects in group I patients. Conclusion: It is safe and effective to use ropivacaine and morphine in thoracic epidural blocks to treat unstable angina pectoris via PCEA. Following up study should be paid in order to ascertain the long term effect.